Blanca González

@blancagonzalez.bsky.social

Pediatric Infectious Diseases interested in Transplantation

In a study of 54,306 admissions, conditional reflex urine culturing reduced UTI antibiotic days by 39.5% (6,914 had UTI antibiotics). No safety issues noted. 🚫💊📉 #idsky

Implementation of Diagnostic Stewardship to Improve Urinary Tract Infection Antibiotic Use Across Three Medical Centers

Overdiagnosis of urinary tract infections (UTIs) and unnecessary antibiotics are common. This is particularly true in older adult populations such as Veterans. Diagnostic stewardship can decrease overdiagnosis and overtreatment, but optimal implementation of such interventions has not been fully studied.MethodsThis was a multicenter hybrid type two effectiveness-implementation study of UTI diagnostic stewardship interventions at three participating VA hospitals. Each hospital implemented one intervention at either the ordering, processing (conditional reflex urine culturing) or reporting stage. The primary outcome was inpatient UTI antibiotic days of therapy (DOTs) per admission evaluated using generalized estimating equations. Secondary outcomes included rates of urine cultures ordered and performed and, a safety measure of secondary bacteremia from a uropathogen.Results37,085 hospital admissions occurred in the pre-intervention phase and 17,221 in the post-intervention phase. Of these, 6,914 (12.7%) included UTI antibiotics. Hospital 3, which implemented conditional reflex urine culturing had a 39.5% reduction in UTI DOT (95% confidence interval (CI), 13.9%, 57.5%) in the year following the intervention. Additionally, hospital 3 noted fewer urine cultures ordered (22.8% immediate and 35.7% slope reduction) and performed (38.9% immediate and 38.8% slope reduction). No change in UTI DOT was observed for ordering or results reporting interventions at other hospitals. There was no difference in the safety measure of uropathogen bacteremia.ConclusionsConditional reflex urine culturing had a large decrease on UTI antibiotic DOTs and urine cultures performed. Health-systems or medical centers starting urine culture diagnostic stewardship should implement conditional reflex urine culturing first.

academic.oup.com

🦠 Fungal meningitis outbreak in U.S. from May 2023 linked to 233 patients in Mexico; 170 contacted (73%). 104 (61%) at risk, 24 diagnosed, 12 (50%) died. All cases from same anesthesiologist. #idsky

Fungal meningitis in U.S. Patients who Received Epidural Anesthesia in Matamoros, Mexico

Fungal meningitis outbreaks are rare and entail high mortality rates. Beginning May 2023, we investigated fungal meningitis caused by Fusarium solani species complex occurring in U.S. patients who received epidural anesthesia in Matamoros, Mexico.MethodsEarly epidemiological information suggested U.S. patients with suspected fungal meningitis had undergone mostly cosmetic procedures under epidural anesthesia performed in two Matamoros clinics. U.S. patients known to have received surgery at these clinics during January 1–May 13, 2023, (clinic closures date) were identified and notified by public health officials. Epidemiological and clinical data were used to update diagnostic and clinical guidance for outbreak response, including use of the experimental antifungal fosmanogepix. Whole genome sequencing was conducted on outbreak isolates.ResultsU.S. public health officials attempted to contact 233 potentially exposed U.S. residents who underwent surgeries, mostly cosmetic, in Mexico, reaching 170 (73%). Of those, 104 (61%) reported receiving epidural anesthesia and were therefore considered potentially at risk for fungal meningitis. At least 30/104 (29%) at-risk patients received a diagnostic lumbar puncture; 24 (23 women, 17 Hispanic or Latino) were diagnosed with fungal meningitis, and six were not. Twelve (50%) with fungal meningitis died. All cases involved epidural anesthesia administered by the same anesthesiologist in Mexico. Whole genome sequencing showed that patient isolates of Fusarium from the two implicated clinics in Matamoros, Mexico, were genetically closely related.ConclusionsClinicians should maintain suspicion for fungal meningitis in patients with negative bacterial culture, viral culture and molecular testing with a history of epidural anesthesia for any reason.

academic.oup.com

‼️Our new paper on social media in #TxID is officially out in @thetxidjournal.bsky.social We summarize findings from our #TxIDChat @txidfellows.bsky.social We discuss recs for trainees, career advancement, & future directions in this changing landscape. Check it out! dx.doi.org/10.1111/tid....

Social Media Savvy, It's More Than Just the #Hashtags: How the Use of Social Media in Transplant Infectious Diseases Can Impact the Field and Patients

dx.doi.org